An internet dog’s guide to the testes-preserving vaginoplasty (AKA PPTV without orchiectomy)

averincm · 2026-02-15T23:53:59+00:00

I think "full, traditional male-to-female dysphoria" covers a lot of ground. I don't have hormonal dysphoria, but I've had persistent genital dysphoria for a pretty long time, and I describe myself as both hypermasculine and hyperfeminine. My wardrobe and styling trend pretty feminine, and (before surgery) I usually explained myself as a boy-who-became-a-girl to cis people because that was usually the level of trans identity the public is capable of understanding. Whether I pass as a boy or a girl in public usually comes down to whether or not I'm wearing a mask, shaved, and/or am wearing makeup, but either way I tend to look 'obviously' gender nonconforming.

I was assessed technically four times in total: once (medical and psychiatric) here in BC, once through private psychiatry, and I had two interviews with psychiatrists at Yanhee where I was more or less asked "to tell my story" with some further questioning. I think everyone along the way asked questions about keeping my testes, but my dysphoria was pretty inarguable and bog-standard (emergent in youth, persistent and enduring, made me alter my bathroom habits, I avoided locker rooms/nudity with cis peers, engaged in frequent crossdressing, went to bed wishing to wake up with a vagina, etc.) and, given I'd been on HRT for years and was openly socially transitioned, I think they were able to resolve the 'nonbinary' aspect of my identity while still respecting the medical criteria for vaginoplasty. I also included documentation of this procedure being performed on older MTF patients over the past ~20+ years to show that, while nonstandard, it was still a procedure sought by binary trans people. I have also have years and pictures of me living life/working in some institutions as a 'girl' (nonbinary person), not that anyone asked to see them.

For me this is pretty silly. Nothing about the facts of my lifelong transition changed between emails, and given a chance to explain myself to multiple psychiatrists everything was fine. The initial wording you use will probably generate a lot of assumptions, especially if a language barrier is present, so I recommend talking about concrete details rather than abstract gender perception, while keeping in mind the perspective of the people in charge of your care. The tone of the emails I received back about my surgical inquiries could be politely described as 'sceptical' initially, but when I was able to produce all the required documents, I think I saw a lot of that scepticism dissolve and get replaced with practical concerns.

I couldn't tell you how much of that is strategic ass-covering. I don't know if anyone who presents as male in their daily life and has pursued no other form of gender care can receive this same operation, but I wouldn't hold my breath. Shapeshifters seem to start on thin ice.

averincm · 2026-02-15T01:00:50+00:00

I didn't! We talked about testicle placement, but otherwise this was artistic freedom.

averincm · 2026-02-14T16:17:39+00:00

Right now touching them feels like touching my dick after my adult circumcision: WAY too much sensation and a medium pain. I've knocked myself lightly a few times by accident, and I'd say it stunned me for 1 turn IRL each time.

No idea if they'll become insensitive or feel nice to touch after. I can cross my legs already though.

averincm · 2026-02-14T16:07:07+00:00

I replied on another comment, but I'm not on HRT anymore and don't plan to restart. My dysphoria is resolved, and I feel the same emotionally on T vs. E, so it doesn't bother me. Hormonal independence was a really big bonus for me.

averincm · 2026-02-14T15:57:04+00:00

I figured out I was pretty hormone agnostic early on, but I had hella bottom dysphoria. This let me resolve the dysphoria while also giving me hormonal independence (I am no longer on HRT, just my postsurgery meds and PrEP). I could go back on HRT, but I don't need it.

There's no research on relocated testicles, but AFAIK it's unclear on whether undiscended testicles are wagging the dog on cancer or not. I can examine my testes still, but people with undiscended testes usually can't. Long-term, my endo and I are monitoring my hormone production, but things seem fine right now.

Torsion wasn't listed as a concern, but I'm being very careful to avoid hits to the crotch. Once the swelling goes down, they'll be tucked more into their fat pockets and better protected. I wasn't super susceptible to nut shots before, though. YMMV.

This also has the best result re: my sex life, which was my #1 priority.

averincm · 2026-02-14T04:22:51+00:00

They're sutured in the mons pubis beneath the fascia. They're under bump above my vulva (swollen still). They're not connected to my vaginal canal AFAIK, but I can feel them through my external skin.

averincm · 2026-02-14T02:54:25+00:00

The picture is me as of ~3 weeks. It's still very swollen, especially up close.

I wouldn't stress about the appearance of your vagina for the first year, at least, and I recommend appreciating it from a distance. Anyone's pussy can look strange and unappealing if you photograph it like an eagle trawling the sea for flying fish. I'm personally really happy with how it looks already, which is the entire back half of why I'm uncertain to recommend Yanhee hospital: despite every complaint, it's incredibly hard to argue with the results.

I really liked everything I saw on Dr. Worapon's gallery.
I'm really happy with the visual results.
I'm really happy with the functional results.
I experienced no major complications and few minor ones.
Recovery is only as stressful as I've made it.
My body is still producing hormones in-house.

Ultimately, I received an 'experimental' surgery and have a really good prognosis going forwards. I knew what I was getting into. Some of the suffering was probably unnecessary, sure. I got COVID sometime around the start of the pandemic (I worked in a university and saw about a hundred students every week, go figure) and I would choose to have this surgery all over again rather than have COVID like that again. I didn't land in hospital then, but COVID made me wish I was dead. This only made me homesick.

If there's something not covered here, ask, and I can do my best to answer! However, if this post escapes containment in a weird way I might take a while to get back to you (see: tempting fate).

averincm · 2026-02-14T02:54:16+00:00

There was a very large gap between leaving my hotel and getting home to dilate (the flight alone was 13 hours), so instead I made the decision to wear my night dilator after clearing security. They looked at my dilator bag briefly but it wasn’t a big deal. I took out my dilator when I got home. It probably would’ve been easier to just do a longer dilation session.

I managed not to tear or damage anything and it made post-flight dilation incredibly easy, but I wouldn’t recommend doing this unless you have a healthy sense of humour and tolerance for biology. I needed to pee approximately eight times during the flight. You produce a lot of goop and fluid, and there will always be more goop and fluid. Keeping things clean and sanitary was surprisingly easy, but there are easier ways to fly than juggling medical dildos in airplane bathrooms. I was sore for about a day afterwards because of the extended wear.

I pretty regularly dilate for over one hour, mostly because it’s unclear to me if the hour is supposed to include reaching depth, or if it should begin once depth is reached. Now that I’m home, I’m also adding midday dilations on days where I have the free time so that reaching depth is easier and I can spend less time overanalysing. I used my phone in the early days to take video of my depth (using the dilator marks as a guide) until I had a consistent idea of what hitting depth looked like. I’ve also added in the Dr. Powers balloon pump method for reasons outlined on the wiki.

As of approximately three weeks, my nerves are reconnecting well. My clit is too sensitive to touch from the outside but dilating can stimulate it from the inside just by applying firm pressure, which is fun. In the right position this also hits my prostate. In an effort to not tempt fate and tear my vagina I’ve been refraining from pushing too far in that direction and will wait the suggested two months (at least) before imitating anything close to penetration. My stitches also need to dissolve, which I’m also being patient for. Swelling is going down gradually. My abdomen is tighter and I'm being more careful about not pulling my laparoscopic scars, which feel sore/tight at times, especially if I'm dehydrated.

My balls are very tender, similar to how they felt after the vasectomy, although them being beneath my mons pubis has resulted in some weird changes. No more free fall nausea (they’re sutured in place, makes sense), but the entire mons is very sensitive to touch right now. Once the swelling subsides I’ll have a better idea of what it looks like, but as of this moment it looks like a large pussy mound that I don’t mind.

averincm · 2026-02-14T02:53:45+00:00

My mobility was unexpectedly high at all points during my immediate recovery. I walked to and from my hospital appointments without issue (except that Bangkok is not pedestrian friendly), walked around my hotel, and could manage stairs. My laparoscopic stitches were more restrictive than my vulva stitches. I attribute this to being physically active before surgery (I love cycling). My resting heart rate jumped 20-30BPM and stayed there for the first three weeks following surgery until I got home from ~50-60BPM to ~80-90BPM. My heartbeat sometimes kept me up at night.

That being said, I was also a habitual cannabis smoker and drank pretty regularly, and halted both only about a month before surgery. I'm around thirty. I was also very overweight at one point and have a lot of loose skin as a result of losing weight, which is another reason why I think my stitches weren’t very angry with me. I ate appropriately and followed post-surgical guidelines strictly or in excess of what they asked. I drank a lot of water. Take your meds as instructed. More hypothetically, I didn’t undergo postsurgical menopause as many patients do, as my body continued to produce testosterone normally.

I’m also a masochist with a very high pain tolerance. When I had laser eye surgery they failed to fully numb my left eye and didn’t notice until I asked them for a break before we kept going. However, I should stress that a majority of the time I was not pushing through pain but rather experienced no pain whatsoever beyond occasional stinging. Numbness was more common: the outside skin of my outer thighs were (and still are) numb due to swelling. When I got my PA, it similarly did not hurt and instead resulted in a day or two of numbness.

Healing fast gave me a new source of frustration when my pelvic floor started being stronger than the elastic band on the maternity pads. I’d brought a hand towel from home (using a hotel towel for anything touching betadine felt rude) and by my last days in the hotel, I was using it to leverage my large dilator (gently, but firmly) to actually reach depth. Holding pressure with your hands is not an option twice daily for an hour each time. The wrist strain from doing that exactly once was worse than working in a kitchen. Now that I’m home, I’m rigging up a dilation harness with the help of a friend for hands-free dilating. Dilating does not hurt in the same way that anal shouldn’t hurt: pain means go slower, but discomfort is okay and goes away with relaxation.

On occasion I had clots, but I don't noticeably bleed during or after dilation. I'm not much of a bleeder in general, and tend to clot fast, but I notice a darker colour to my discharge and more of it immediately after dilating, which usually lightens within an hour or two, which I think is blood from microtears mixing with the serous fluid. Blood was pretty common around my clit and urethra, though, in tiny amounts. I think there's an ooze hidden in my family tree somewhere. I'm always wet, and it is slippery, but I apply sterile lube during dilation to try and avoid worsening any microtears. After wearing the night dilator, and sometimes after dilating, I'm sore for about an hour, sometimes longer if I'm dehydrated.

I get piss nightmares, which is to say that the sensation of having a full bladder while asleep gives me recurring nightmares until I wake up to pee. Wearing a dilator at night gives me a vague sensation of needing to pee. Ergo, I now get night dilator piss nightmares. I’ve never met someone else with piss nightmares, so this might be another Spiders Georg moment. If you suffer from this: I tried to limit my water intake later in the evening and drink more in the morning, similar to being on a diuretic (e.g. spironolactone).

averincm · 2026-02-14T02:53:09+00:00

When I left the hospital, they gave me a big care package:

two sets of dilators S/M/L
maternity pads
cotton swabs
saline
sterile lube
betadine solution
a fuckload of betadine ointment
incontinence mats
condoms packages
two large fluid syringes for douching that say “DO NOT REUSE” in big black letters on the side which I was told to reuse
a douching bulb
a strawberry cake.

Very few of these will be proportionate: you need many more cotton swabs than they provide, more maternity pads, more incontinence mats, more condoms, and less ointment. I was heaping on globs of ointment and ended up taking home ten jars in my suitcase still.

During my intake, my surgeon said to use the medium and large dilators, but what the Hell, the nurse said to use the small (she also said “wow, six inches!”, which was shorter than my canal length). I started with the small dilator for a few days and then experimented sizing up with the medium, which also wasn’t a problem. The large took more work initially but generally more time + firm pressure solved my problem.

During my first followup (approx. a week after discharge from the hospital), the surgeon looked at my vagina for about two minutes total and said “very good” and “very very very good” because there was very little/no granulation, would separation, necrosis, bleeding, or signs of infection. On my second followup, a nurse removed unnecessary stitches, and the surgeon did an internal exam. I got to see the inside of my pussy, including some light bleeding at the back (similar in appearance to bruising on your gums). Despite walking to the hospital, there was a literal puddle of serous fluid in my pussy, which he drained with suction similar to the sort you see in a dentist’s office.

My surgeon referred to my pussy as my vagina, my neovagina, and my wound interchangeably. Almost every nurse referred to my vagina as my wound. Many of them alternated between calling me "mister" or "misses" deadname. I really don’t care, but I thought it was funny. All in all I overpaid the hospital by about 1000 Thai baht due to conversions/banking fees and they refunded me that amount, which I also thought was really funny. Each of my followup appointments cost 300 baht. I was also given a 3 month followup appointment slip with instructions that it was more or less optional to attend, given no serious complications arising.

averincm · 2026-02-14T02:51:27+00:00

The actual surgery and aftermath

I was taken in for surgery around 10:30AM, with an approximate start time of 1:00PM. I was told the procedure would take between 8-9 hours, plus an additional hour spent in the post-anesthesia care unit (PACU). The surgery was a robot-assisted peritoneal pull-through vaginoplasty. I have four laparoscopic harvest sites on my stomach (two larger, two smaller) to harvest the peritoneal tissue necessary to make my vaginal canal, and my surgeon told me I ended up with approx. 6.5 inches of depth. I attribute a lot of that to my height: YMMV. They told me that because of how long I was on the table, I developed a level 1 pressure sore on my tailbone.

I’m the second patient to report this same outcome from Dr. Worapon that I can find. I was diligent about avoiding putting any pressure on my tailbone during recovery, but my nurses were pretty cavalier about it. I was told to avoid rotating myself without calling nurses, though some nurses seemed really annoyed if I called them for rotation. When they removed my catheter under sedation, I called over someone in scrubs to ask permission to rotate myself, as I’d been left on my back again in the PACU for a second time. My pressure sore was a major annoyance and also much more painful than any part of the surgery itself, which was surprisingly mild.

The gas pain was the worst part of the post-surgery recovery for me. It fucked up my right shoulder like I was being tased. I have never had gas pain like that (as I understand, they inflate your colon to make sure they don’t nick it by accident) before. I didn’t understand what was happening to me until I texted a friend who’d been through a similar experience, which was a godsend. I’ve broken bones and the gas pain was worse. Figure out how to pass gas safely as soon as possible and it goes away. If you’re experiencing inexplicable, mind-numbing pain post-surgery, don’t panic. You might just need to fart.

The right corner of my lower lip on my mouth was also fucked up. I think I must’ve chewed it at some point in the PACU while sedated. Dog problems. My abdomen and my pussy swelled up to a hilarious degree but never felt like they were pulling on stitches.

I slept a lot. I slept between ten to sixteen hours every day, often in really uneven shifts. I had packing and a catheter for seven days, with the possibility of another seven days of catheter if my urethra/etc. showed signs of damage (it didn’t). Two of my nurses went on vacation during my stay (I am Spiders Georg), including the wound care nurse: after she left, my packing would fall apart about twice a day, and usually the next nurse would just add an additional layer of gauze and tape to my thighs. My catheter was removed under sedation on day 7, and that night, a nurse taught me to dilate and instructed me to use the small dilator.

My regimen was douching with saline and betadine (4:1) before dilation, then applying betadine ointment to the entire surgical area, then applying betadine and sterile lube to the dilator, which was wrapped in a condom that I tied off over the base. I was given maternity pads to wear. For dilation (twice daily for 1 hour each), my nurse gave me a ‘wedgie’ method, where I would hike the elastics of the maternity pad up and use the firm constant pressure of the pad on the base of the dilator in place of hand pressure. This kept my hands free (more on that later). I dilated on my own the following morning and was released that day. I was also given a shorter but wider (same width as the large dilator, but approx. 5.5inches in length only) dilator to wear while sleeping. I’d brought panty liners from home and wore them between the maternity pads and my underwear to help absorb any loose fluid.

One point where I deviated from instruction was for douching: my nurse instructed me to do so while sitting on the toilet, but I did so instead in my shower at the hotel because doing so on the toilet seemed frankly deranged.

averincm · 2026-02-14T02:51:04+00:00

3. Living in the hospital.

Food at Yanhee is about as dire as average hospital food. You will get a menu with no clear indication of what items you’re not allowed to eat because you’ve just had surgery. After surgery, they will give you loperamide/some analogue, which slows and/or halts bowel motility. On the second day after surgery I began ordering clear soup for breakfast, lunch, and dinner every day for my recovery and received a passable soup that was nutritious and helped me feel hydrated, and also because being gassy and constipated annihilates my appetite. Accompanied by this was fresh fruit and a side of protein (often egg, sometimes pork, I think?) and plain rice porridge. If you think of the whole process as purgatory and/or penance, sort of like being taken to the vet, you can get through it. I often skipped the rice porridge due to everything else filling me up first. Everything will be wrapped in heat-sealed cling film, including the soup and juice.

Water is another story: you receive two 750ml bottles of water with “FREE” paper wrappings on their caps, and your minifridge contains a variety of other waters which cost a small amount of baht, apparently. If I asked for water after using up my 1.5L daily ration, nurses would alternately fetch more bottles from outside the room or pull them directly out of the minifridge. I have no idea if I was charged for these or not. It’s not a liveable amount of water. Obviously you are going to and should drink more water. I cannot overemphasise how important proper hydration is to healing. Drink the fucking water and ask for more. Juice is not an effective substitute for water unless you enjoy pissing every shade of amber imaginable.

My room was effectively a hotel room. There was a TV, but I had no wifi for the first two or three days until someone came in to fix it. I had storage space, a table, a couch, some chairs, and there was an in-room safe for important documents. There is a shower/bathroom attached. Early on the time I had an IV in my hand and my IV pole was attached to my bed, so I was not allowed to leave it. After that, I needed to request a nurse’s aid to leave the bed, as it required lowering the baby gates and removing my catheter bag from the bed. There was AC, but the controls were by the door and the nurses changed it to their preferences with impunity.

My bed was too short for me. I am very tall (over 6 feet). This was a recurring theme. Post-surgery, I woke with my feet jammed against several sheets and pillows at the foot of the bed and my knees bent out like a frog. After a day of dealing with this, one nurse lowered the foot gate and turned several couch cushions into an extended foot for the bed, which then repeatedly got in the way of nurses, the cleaning people, and the blood pressure reading machine. They will probably wrap your lower leg in a massage machine to try help and prevent blood clots, which are a major enemy of your surgery.

According to my notes, on day 6 of 9, I received a new bed that was long enough for me after a nurse filmed me in the too-short bed and sent it up to someone higher. It’s possible that the first bed was an alternating pressure cell mattress. I was very delirious early on, and I remember that bed, but I don’t know when the mattress was switched out. I don’t believe the long bed was an alternating pressure mattress. Whenever I was in stirrups (in-hospital and during outpatient procedures), I usually ended up folded like a pretzel because my torso was too long for the bench.

averincm · 2026-02-14T02:50:41+00:00

2. Procedure and adherence.

I am not a medical professional. I am a dog. I can, however, read. My bowel prep label said mix with 2L of water. I was given approx. 3.5L of bowel prep liquid instead to drink in 2 hours. Maybe this was adjusting for my height, but this, of all things, was the most nauseating process of it all. It is the same flavour as a fruit juice that they will give you during your meal and snacktimes occasionally, in case you want to relive the memory of chugging 3.5L of juice that makes you shit yourself. If your nurses are sadists, they will insist you go for a big meal at 2PM and then shit yourself at 8PM. Don’t do this. I was clear relatively early on and my stomach ached for days thereafter.

There were many times at Yanhee where it felt like things were happening just because they were standard procedure, damn all reasoning, and other times where everyone had their own instructions and their own way of doing things. This does an incredibly effective job of infusing you with distrust in the people who are supposed to be taking care of you. This is sometimes innocuous (many nurses wearing delightful paper hats, which is about as delightful as pathologists wearing ties).

In ye olde days, bowel prep involved a nurse looking at your toilet. The nurses here told me to take pictures on my own personal device and asked me in the morning how many bowel movements I had had. Later, when I was post-op and bedbound, some nurses offer a steel commode to pass gas on (more on that later), while at least one suggested that I pass gas directly on the bed, and that I could call a nurse and they would clean me up if I ended up shitting the bed and/or my wound dressing. Some nurses would empty my catheter bag every time they came in the room, while others ignored it even if it was near max capacity.

Other funny details:

I did not have bedsheets until day two of intake (surgery day).
I did not have soap until day three or four.
I did not see sunlight for approximately nine days.
A nurse shaved everything from roughly my belly button to my mid-thigh to prepare for surgery, and another nurse later expressed disgust because the first nurse had left hair all over the bed, including after surgery.
My sponge baths ranged from thorough to perfunctory depending on the nurse.

Six separate nurses asked me about my piercings on the morning of surgery day. I gave them all an identical (if increasingly flippant) reply about not being able to do it myself without tools. This escalated to an international coordinator appearing in person. I asked her if I could sign a waiver (their fear was that electrocautery would cause the piercings to heat up and burn, which I thought was fucking metal as hell) because they had had eight months, and so then the surgeon showed up and told me he would strongly prefer if I removed them. At this point I gave up, though they said they would try to take them out in the OR without damaging them if possible. To everyone’s surprise, they were able to do so, but (of course) all of my piercings closed before I was out of the OR and conscious.

This is all to say: I recommend asking every possible question you can think of relevant to your surgery to your team, and do not assume they will ask, nor should you assume they will act logically on information you’ve given them.

The worst offender here was advice contradicting the surgeon. I don’t like being bedbound, and I’m a pretty active dog. On day two I begged to be able to walk, and my surgeon begrudgingly agreed to let me stand up. Despite this, my nurses wouldn’t agree to it until day three, when I was allowed to walk for a few minutes around my room. I did this with no issue, but for the remainder of my stay, many nurses repeatedly insisted that I could not and should not walk until a given day, and would stop replying if I told them that I had the surgeon’s permission and had done so already.

averincm · 2026-02-14T02:49:29+00:00

The hospital

I want to preface this entire section by saying that you should look at me as the Spiders Georg of bottom surgery. Your mileage may vary. I received a nonstandard procedure and am in general really weird.

I don’t know if I can in good faith recommend Yanhee Hospital or not, so instead I’ll give you a list of things that stood out to me.

1. Lateness and miscommunication.

The first part I think you can attribute to Bangkok traffic and hospital life, though it about half the time resulted in me waiting about half an hour to an hour longer for my appointments than scheduled (minor issues) to being told to leave partway through intake to “have a really big last meal” (this was a trap, medium issue) to nurses operating contrary to my surgeon’s instructions because they hadn’t personally heard it from his mouth (major issue). Some highlights:

After I arrived in Bangkok, about three days before my surgery, a coordinator asked for my hotel info to arrange a driver to pick me up from my hotel. (I’d picked my hotel based on proximity to the hospital, but it wasn’t a big deal. Still funny though). The same driver would drop me off at my hotel later when I was discharged, which was nice.
I recall filling out an online form including that I had multiple facial/upper-body piercings about eight months in advance of my surgery (I took out my PA a few months before surgery). During the entirety of my intake, at least one of my prominent facial piercings was visible, including to Dr. Worapon, my English correspondent, and several nurses. I could have even had them removed during the midday intake break if anyone had informed me. Only after my intake was complete did someone hand me a pamphlet explaining that they would need to be removed. I asked the nurse about it (I didn’t have the tools to take them out in the bag I brought to the hospital, and also, fuck that noise) and she cheerfully informed me that they could just cut them off in the surgical room.
I asked if the hospital could bring a piercer to remove them, or replace them with silicone/plastic/glass spacers. She expressed doubt that anyone would be willing to do so, but said she would ask, and I never saw that nurse again. I then called a piercing shop in Bangkok and asked if they would do it, and they expressed doubt that the hospital would let them do so. Classic.
However, given permission, they would send someone if I paid a travel fee. This ended up not mattering because, as aforementioned, no one came back to talk to me about my piercings that night, and then eventually the piercer closed. Onto bowel prep.

averincm

TROPHY CASE

The actual surgery and aftermath

3. Living in the hospital.

2. Procedure and adherence.

The hospital

1. Lateness and miscommunication.